Initial Pass Research Articles

The Feasibility of Quality Assurance in the TOPGEAR International Phase III Clinical Trial of Neoadjuvant Chemoradiotherapy for Gastric Cancer (An Intergroup Trial of the AGITG/TROG/EORTC/CCTG)

The TOPGEAR (Trial of Preoperative Therapy for Gastric and Esophagogastric Junction Adenocarcinoma) international phase III trial hypothesized that adding preoperative chemoradiation (CRT) to perioperative chemotherapy will improve survival in patients (pts) with gastric cancer. Owing to the complexity of gastric irradiation, a comprehensive radiation therapy quality assurance (RTQA) program was implemented. The objective of this report is to describe the RTQA methods and outcomes.RTQA was undertaken in 'real time' prior to treatment for the first 5 pts randomized to CRT from each center. Once acceptable quality was achieved, RTQA was completed for one third of subsequent cases. RTQA consisted of evaluating the following parameters: 1) clinical target volume (CTV) and organ-at-risk (OAR) contouring; 2) RT planning parameters (CT simulation, dose prescription/planning technique, per-protocol planning constraints). Protocol violations between high- (defined as 20+ pts enrolled) and low-volume centers were compared using Fisher's exact test.As of December 2020, 554 pts from 70 centers were enrolled. In total, 277 were randomized to receive RT and 196 (71%) were included for RTQA; of these, 57 (29%) and 139 (71%) were from high- and low-volume centers, respectively. The initial RTQA pass rate was 72% (n = 141). There was no significant difference in the initial pass rate between the high- and low-volume centers (79% vs 69%; P = 0.22) For the 55 cases requiring resubmission, detailed feedback was provided, and most cases had multiple protocol violations. At least one aspect of the CTV had to be adjusted in 49/55 (89%) cases with inadequate coverage of the duodenum down to the 3rd part most commonly seen (n = 28/55, 51%). Table 1 summarizes CTV contouring protocol violations. OARs were generally appropriately contoured with five (9%) cases requiring adjustment. Two cases failed RTQA due to treatment planning violations (kidney dose, lung dose) in absence of contouring (CTV, OAR) concerns. Following resubmission, 192 (98%) passed RTQA and four (2%) required a second resubmission.In a large multicenter trial RTQA is feasible and effective in achieving high quality RT treatment plans. Ongoing education and audits should be performed to ensure consistent quality of treatment plans over the study period.

Non-syndromic pheochromocytoma: From post-operatory scores to lifetime follow-up

We introduce a case report of an adult male diagnosed with non-syndromic pheochromocytoma with a first pathological post-operatory report of malignant type with further re-considerations during follow-up for a 6-year period of time. This is 46 - year old male admitted for: post-adrenalectomy status reassessment. In 2013 he was diagnosed with high blood pressure requiring a complex regime of anti-hypertensive drugs to control it. In 2015 he was referred for an endocrine check-up which revealed a pheochromocytoma (noradrenaline type). Computed tomography imaging of the abdomen showed a right adrenal tumor of 28/38 mm, a mass that was clearly contoured, with heterogeneous pattern, and with moderate caption of intravenous contrast. Laparoscopic right adrenalectomy is performed with normalization of high pre-operatory normetanephrines and a dose reduction of anti-hypertensive medication which was still necessary. Pathological report suggested a malignant pheochromocytoma; the initial PASS score of 8 was later re-calculated, and a GAPP score of 5 was achieved showing a moderately differentiated tumor. No genetic backup was identified. Within the first year after tumor removal, the patient suffered a stroke, proving the higher cardiovascular risk than general population even after hormonal imbalance is restored. Lifelong surveillance is the rule.

Evaluation of subcooled MQL in cBN hard turning of powder-based Cr-Mo-V tool steel using simulations and experiments

Metal cutting fluids for improved cooling and lubrication are an environmental risk and a health risk for workers. Minimizing water consumption in industry is also a goal for a more sustainable production. Therefore, metal cutting emulsions that contain hazardous additives and consume considerable amounts of water are being replaced with more sustainable metal cutting fluids and delivery systems, like vegetable oils that are delivered in small aerosol droplets, i.e., via minimum quantity lubrication (MQL). Since the volume of the cutting fluid in MQL is small, the cooling capacity of MQL is not optimal. In order to improve the cooling capacity of the MQL, the spray can be subcooled using liquid nitrogen. This paper investigates subcooled MQL with machining simulations and experiments. The simulations provide complementary information to the experiments, which would be otherwise difficult to obtain, e.g., thermal behavior in the tool-chip contact and residual strains on the workpiece surface. The cBN hard turning simulations and experiments are done for powder-based Cr-Mo-V tool steel, Uddeholm Vanadis 8 using MQL subcooled to −10 °C and regular MQL at room temperature. The cutting forces and tool wear are measured from the experiments that are used as the calibration factor for the simulations. After calibration, the simulations are used to evaluate the thermal effects of the subcooled MQL, and the surface residual strains on the workpiece. The simulations are in good agreement with the experiments in terms of chip morphology and cutting forces. The cutting experiments and simulations show that there is only a small difference between the subcooled MQL and regular MQL regarding the wear behavior, cutting forces, or process temperatures. The simulations predict substantial residual plastic strain on the workpiece surface after machining. The surface deformations are shown to have significant effect on the simulated cutting forces after the initial tool pass, an outcome that has major implications for inverse material modeling.

Rapid On Site Evaluation (ROSE): A Pathologists’ Perspective

Rapid on site evaluation (ROSE) has been recognized as a safeguard to help ensure adequate aspirate or biopsy sample is present for diagnostic evaluation. The method involves having a pathologist (generally a cytopathologist) on site during specimen collection to allow for feedback for the performing proceduralist. ROSE can allow for appropriate ancillary tests to be collected at the time of biopsy (eg, flow cytometry or cultures), fewer passes in the event of adequate lesional representation on initial pass(es), or adjusting the biopsy target. This article was written from the pathologists' perspective in terms of things that improve their ability to be of value on site. As you might imagine, a lot of it comes down to communication; in a sense taking advantage of the opportunity of having both the radiologist and pathologist in the same room. While not every institution has the staffing to provide ROSE, for those that do it's a good exercise to occasionally sit down and examine how to get the most out of the unique collaboration that is ROSE.

The efficacy of continuous use disposable N95 masks in clinical practice in the emergency department.

During the SARS-CoV-2 pandemic, many emergency departments (EDs) initiated continuous use of N95 disposable respirators (N95s) rather than discarding them after each use to conserve respirators. This study investigates the efficacy of wearing disposable N95s continuously during clinical work.MethodsThis is a prospective cohort study of ED staff required to wear N95s continuously throughout their shifts. Subjects were doctors, nurses, and technicians who were previously fitted for their assigned N95 by employee health. Subjects were fit tested periodically throughout their shifts. Investigators filled out a questionnaire for each subject noting the hours of continuous N95 wear. Data were analyzed using descriptive statistics.ResultsOne hundred thirteen N95s were evaluated, with 23 failures at first testing. These were not retested. Twenty-seven N95s passed at the start of a shift and did not have repeat testing during the course of the shift. These were excluded from further analysis. Seventeen N95s passed testing after several hours of continuous wear, but only had a single fit test done partway or at the end of a shift. These were assumed to have passed if tested at shift start, and were assigned as “passes” for continuous use. Forty-six N95s had an initial pass and were evaluated for continuous use, of which 6 subsequently failed later in the shift, giving a fail rate with continuous use of 9.5%.ConclusionContinuous use of disposable N95s throughout an ED shift is reasonable during a PPE shortage if wearers are assured of fit at the start of their shift.

감나무 부산물로부터 제조된 셀룰로오스 나노피브릴의 물성 평가

In this study, we evaluated the applicability of fruit by-products as raw materials for the production of cellulose nanofibril (CNF). The persimmon byproducts generated by pruning persimmon trees were collected and used for the manufacture of bleached kraft pulp and CNFs. The persimmon byproduct bleached kraft pulp (PB-BKP) was made at the optimum pulping and bleaching conditions reported in the previous study and the CNFs were made from PB-BKP and commercial hardwood bleached kraft pulp (Hw-BKP) by refining and micro-grinding processes. After micro-grinding, the particle size, viscosity, zeta potential, and fiber width were evaluated according to the pass number of fibrillation. The appearance of the CNF slurries showed no significant difference between PB-BKP and Hw-BKP. It was found that nanoization of PB-BKP and Hw-BKP proceeded sufficiently when the pass number was five or more. In addition, as the pass number increased, the low shear viscosity of CNF increased, the particle size decreased, and no significant change was observed in the zeta potential. Looking at each pulp, CNF made of PB-KBP had higher fiber width and particle size than Hw-BKP in the initial pass number, but the difference decreased when the pass number was nine. Therefore, CNF made with PB-BKP and CNF made with Hw-BKP showed similar characteristics after the sufficient pass number of micro-grinding. Based on the results, we concluded that persimmon tree by-products can be used as raw materials for the production of CNF.

The role of fit testing N95/FFP2/FFP3 masks: a narrative review.

For healthcare workers performing aerosol-generating procedures during the COVID-19 pandemic, well fitted filtering facepiece respirators, for example, N95/FFP2 or N99/FFP3 masks, are recommended as part of personal protective equipment. In this review, we evaluate the role of fit checking and fit testing of respirators, in addition to airborne protection provided by respirators. Filtering facepiece respirators are made of material with sufficient high filter capacity to protect against airborne respiratory viruses. Adequate viral protection can only be provided by respirators that properly fit the wearer's facial characteristics. Initial fit pass rates vary between 40% and 90% and are especially low in female and in Asian healthcare workers. Fit testing is recommended to ensure a proper fit of respirators for the individual healthcare worker so that alternative respirators can be selected if required. Although fit testing is required to comply with respirator standards, it is not performed consistently within all healthcare settings. Fit checking (a self-test) is recommended every time a healthcare worker dons a respirator, but is unreliable in detecting proper fit or leak. Additionally, fit testing has a high educational value and as such is best performed as part of a hospital respiratory protection programme. Whether fit checking alone, as opposed to fit tested and fit checked respirators, provides adequate airborne protection against aerosols containing the SARS-CoV-2 virus and other respiratory viruses remains unknown. While fit testing undoubtedly incurs additional costs, it is still recommended, not only to protect healthcare workers but also as it may reduce overall healthcare cost when considering the potential costs of sickness leave and the associated legal costs of compensation.

Iatrogenic gallbladder perforation secondary to Veress needle placement: a complication of robotic nephrectomy

Our patient initially presented to the Urology service for robotic-assisted right simple nephrectomy due to complications from a ureteral stricture and recurrent obstructive pyelonephritis. In the operating room, the patient...

A KNIME Workflow for Automated Structure Verification.

Adequate characterization of chemical entities made for biological screening in the drug discovery context is critical. Incorrectly characterized structures lead to mistakes in the interpretation of structure-activity relationships and confuse an already multidimensional optimization problem. Mistakes in the later use of these compounds waste money and valuable resources in a discovery process already under cost pressure. Left unidentified, these errors lead to problems in project data packages during quality review. At worst, they put intellectual property and patent integrity at risk. We describe a KNIME workflow for the early and automated identification of these errors during registration of a new chemical entity into the corporate screening catalog. This Automated Structure Verification workflow provides early identification (within 24 hours) of missing or inconsistent analytical data and therefore reduces any mistakes that inevitably get made. Automated identification removes the burden of work from the chemist submitting the compound into the registration system. No additional work is required unless a problem is identified and the submitter alerted. Before implementation, 14% of samples within the existing sample catalog were missing data on initial pass. A year after implementation, only 0.2% were missing data.

ParPaRaw

Parsing is essential for a wide range of use cases, such as stream processing, bulk loading, and in-situ querying of raw data. Yet, the compute-intense step often constitutes a major bottleneck in the data ingestion pipeline, since parsing of inputs that require more involved parsing rules is challenging to parallelise. This work proposes a massively parallel algorithm for parsing delimiter-separated data formats on GPUs. Other than the state-of-the-art, the proposed approach does not require an initial sequential pass over the input to determine a thread's parsing context. That is, how a thread, beginning somewhere in the middle of the input, should interpret a certain symbol (e.g., whether to interpret a comma as a delimiter or as part of a larger string enclosed in double-quotes). Instead of tailoring the approach to a single format, we are able to perform a massively parallel finite state machine (FSM) simulation, which is more flexible and powerful, supporting more expressive parsing rules with general applicability. Achieving a parsing rate of as much as 14.2 GB/s, our experimental evaluation on a GPU with 3 584 cores shows that the presented approach is able to scale to thousands of cores and beyond. With an end-to-end streaming approach, we are able to exploit the full-duplex capabilities of the PCIe bus and hide latency from data transfers. Considering the end-to-end performance, the algorithm parses 4.8 GB in as little as 0.44 seconds, including data transfers.

Numerical and experimental study of a 5754-aluminum alloy processed by heterogeneous repetitive corrugation and straightening

Repetitive corrugation and straightening (RCS) is a process that induces cyclic plastic deformation on sheet geometries, reporting promising improvements in mechanical properties in metals and alloys. Alternative die geometries, as well as the effect of the process over strain-hardenable alloys, have not been widely studied. In this work, sheets of the aluminum 5754 alloy were processed by RCS, using a novel die design to induce heterogeneous repetitive plastic deformation at room temperature. Numerical 3D Finite Element Analysis (FEA) was performed using the new die; the changes in the homogeneity of deformation, ductility and mechanical strength due to the process were studied. The processed samples were mechanically characterized by means of microhardness and tensile tests. Global and local XRD peak broadening were measured for determining the microstrain evolution during the process. After the initial heterogeneous RCS pass, a decrement in ductility was observed, but the increase in yield strength was significant. The microhardness mapping showed a heterogeneous distribution of the deformation with good agreement with the numerical simulation. XRD peaks width enlarged with the heterogeneous RCS passes in concordance with the mechanical results.

Creep behavior of solid solutioned and annealed Al-7075 alloy processed by equal channel angular pressing

Effect of equal channel angular pressing ECAP process on creep properties of solid solutioned and annealed Al-7075 alloy was investigated at different temperatures and applied stresses. The microstructures of treated alloys before ECAP process were analyzed via transmission electron microscopy (TEM) and electron back scatter diffraction (EBSD). Mechanical properties of ECAPed alloy were also characterized. The fracture surface of samples was also observed by scanning electron microscopy (SEM). Subsequently, the creep mechanisms at different temperatures and stresses were discussed. The results showed that applying the initial pass of ECAP can effectively improve the mechanical properties and creep resistance of Al-7075 alloys due to impeding the dislocations movement as a result of dislocation density growth. However, applying multi passes of ECAP on annealed Al-7075 alloy did not have a positive effect on creep strength. Increasing the fraction of HAGBs and grain refinement of multi-pass annealed Al-7075 ECAPed alloy deteriorate the creep characteristic. The maximum creep rate was achieved for annealed sample after 1 pass of ECAP at 503 K under 70 MPa. Furthermore, according to different values of stress exponent, n, creep mechanism of treated samples altered. Dislocation creep as a dominant creep mechanism of annealed Al-7075 ECAPed alloy at both temperatures (503,543 K) was not altered after initial pass of ECAP; however it was replaced by grain boundary sliding after multi passes of process. Core creep mechanism of solid solutioned sample was also changed from Coble diffusion creep to viscos glide dislocation after one pass of ECAP.

Investigation of mechanical properties of nanostructured Al-SiC composite manufactured by accumulative roll bonding

To manufacture high-strength, fine dispersed and uniform distribution of Al-5 vol.% SiC composite, accumulative roll bonding process is proposed and applied through this study. The microstructure illustrates and validates a good distribution of SiC reinforced in the Al 1050 matrix. It is found that after eight pass, the mean grain size of the composite sample is 188 nm. It can be concluded from tensile test that by increasing the number of passes the strengths of both Al ARBed and composite samples increase; however, their ductility decreases at the initial accumulative roll bonding pass and then increases. The tensile strength of Al-SiC composite sample is greater than the annealed Al 1050 used as the original raw material by five times. The strengthening of the proposed composite sample occurs due to grain refinement, uniformity, reinforcing role of particles, strain hardening, bonding quality and size of particles. From the hardness test, it is concluded that, after the initial pass, hardness increased quickly, then dwindled and finally saturated by further rolling. Observations discovered that the failure mode in the composite occurs due to the shear fracture. From the experimental investigation, governing equations are derived to describe the effect of the number of accumulative roll bonding passes on the tensile strength and elongation of manufactured metal matrix composite materials. It is found that the tensile strength and elongation can be described as an exponential function of the number of passes. Numerical results from these equations are more consistent with the experimental investigation.

Electrochemical conversion of methane to ethylene in a solid oxide electrolyzer

Conversion of methane to ethylene with high yield remains a fundamental challenge due to the low ethylene selectivity, severe carbon deposition and instability of catalysts. Here we demonstrate a conceptually different process of in situ electrochemical oxidation of methane to ethylene in a solid oxide electrolyzer under ambient pressure at 850 °C. The porous electrode scaffold with an in situ-grown metal/oxide interface enhances coking resistance and catalyst stability at high temperatures. The highest C2 product selectivity of 81.2% together with the highest C2 product concentration of 16.7% in output gas (12.1% ethylene and 4.6% ethane) is achieved while the methane conversion reaches as high as 41% in the initial pass. This strategy provides an optimal performance with no obvious degradation being observed after 100 h of high temperature operation and 10 redox cycles, suggesting a reliable electrochemical process for conversion of methane into valuable chemicals.

Effect of gradient temperature rolling on microstructure of initial pass of ultra-heavy plates

In this paper, the gradient temperature rolling (GTR) method is used to establish the rolling model of the first two passes by using the deform-3D finite element software. The variation of temperature field, stress field, static recrystallization and average grain size of ultra-heavy plate slab under different conditions is systematically studied. Test result shows that the water cooling between the passes can form a temperature gradient layer (about 30mm) of a certain thickness on the surface of the rolled blank, the deformation of the core can be effectively improved during the rolling process, the static recrystallized grain size and average grain size of the surface of the rolled part are more obvious than the uniform temperature rolling; in addition, since the surface temperature of the water-cooled product is low, the amount of deformation is small, and metastable dynamic recrystallization does not occur.

Experimental and numerical investigation on strengthening mechanisms of nanostructured Al-SiC composites

In this paper, an accumulative roll bonding (ARB) process is exploited to produce high-strength, fine dispersed and uniform distribution of Al-5vol.%SiC nanocomposite. The microstructure illustrates and validates a good distribution of SiC reinforced in the Al 1050 matrix. It is observed that, an increasing of ARB passes tends to decrease and refine the size of SiC particle to nanoscale. It is concluded from tensile test that, as number of passes increases, strengths of Al ARBed and composite samples are improved. However, their ductility decreases at initial ARB pass and then increased. The Al-SiC tensile strength of nanocomposite sample is greater 5 times than the annealed Al 1050 used as the original raw material. The strengthening of composite sample occurs due to grain refinement, uniformity, reinforcing role of particles, strain work hardening, and bonding quality. From hardness test, after the initial pass, the hardness improved quickly, then dwindled and finally saturated by further rolling. Experimental data is exploited to derive governing equations describe the effect of the number of ARB passes on the tensile strength and elongation of manufactured nanocomposite samples. It is found that, the tensile strength and elongation can be described as an exponential function that depends on the number of passes. Numerical results from these equation are more consistent with experimental investigation.

Correction: The impact of ribosomal interference, codon usage, and exit tunnel interactions on translation elongation rate variation.

[This corrects the article DOI: 10.1371/journal.pgen.1007166.].

Surface characteristics enhancement of MWCNT alumina composites using multi-pass WEDM process

Machining of ceramic composites in electrical discharge machining process is often associated with high roughness, unwanted surface and subsurface defects. This situation is generally not desired as it will reduce the life of the ceramic components fabricated in this machining process. Thus, an improvement towards enhancement of surface characteristics is desired. Multi-pass wire electrical discharge machining process can serve as an effective means of enhancing the surface characteristics in machining of ceramic composite. The current work utilizes the multi-pass concept to improve the surface properties of multi-walled carbon nanotubes filled alumina composites. A decreasing nature of surface roughness is observed with increase in the number of machining passes. A lesser appearance of unwanted debris and cracks is observed at the end of the final pass on the machined surface. The spalling effect is found to be more dominant at the initial first pass while melting and evaporation effect is more dominating in higher passes. Also, a better subsurface characteristic with lesser porous recast layer is observed with increase in the number of passes.

The impact of ribosomal interference, codon usage, and exit tunnel interactions on translation elongation rate variation.

Previous studies have shown that translation elongation is regulated by multiple factors, but the observed heterogeneity remains only partially explained. To dissect quantitatively the different determinants of elongation speed, we use probabilistic modeling to estimate initiation and local elongation rates from ribosome profiling data. This model-based approach allows us to quantify the extent of interference between ribosomes on the same transcript. We show that neither interference nor the distribution of slow codons is sufficient to explain the observed heterogeneity. Instead, we find that electrostatic interactions between the ribosomal exit tunnel and specific parts of the nascent polypeptide govern the elongation rate variation as the polypeptide makes its initial pass through the tunnel. Once the N-terminus has escaped the tunnel, the hydropathy of the nascent polypeptide within the ribosome plays a major role in modulating the speed. We show that our results are consistent with the biophysical properties of the tunnel.

True communication skills assessment in interdepartmental OSCE stations: Standard setting using the MAAS-Global and EduG

BackgroundComparing outcome of clinical skills assessment is challenging. This study proposes reliable and valid comparison of communication skills (1) assessment as practiced in Objective Structured Clinical Examinations (2). The aim of the present study is to compare CS assessment, as standardized according to the MAAS Global, between stations in a single undergraduate medical year. MethodsAn OSCE delivered in an Irish undergraduate curriculum was studied. We chose the MAAS-Global as an internationally recognized and validated instrument to calibrate the OSCE station items. The MAAS-Global proportion is the percentage of station checklist items that can be considered as ‘true’ CS. The reliability of the OSCE was calculated with G-Theory analysis and nested ANOVA was used to compare mean scores of all years. ResultsMAAS-Global scores in psychiatry stations were significantly higher than those in other disciplines (p<0.03) and above the initial pass mark of 50%. The higher students' scores in psychiatry stations were related to higher MAAS-Global proportions when compared to the general practice stations. ConclusionComparison of outcome measurements, using the MAAS Global as a standardization instrument, between interdisciplinary station checklists was valid and reliable. Practice implicationsThe MAAS-Global was used as a single validated instrument and is suggested as gold standard.